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NPI Code Detail

MEDICARE: COURTNEY LEE DERICHSWEILER

MEDICARE:   COURTNEY LEE DERICHSWEILER
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103K00000XBehavior Analyst

General Provider Information

NPI Number : 1770236531
Entity Type Code : Individual
Provider Name (Legal Business Name) : COURTNEY LEE DERICHSWEILER
Provider Business Mailing Address
First Line : 2725 ROSANNA ST
Second Line :
City : LAS VEGAS
State : NV
Zip : 89117-3047
Country : US
Telephone Number : 209-559-8999
Fax Number :
Provider Business Practice Location Address
First Line : 5765 S RAINBOW BLVD STE 111
Second Line :
City : LAS VEGAS
State : NV
Zip : 89118-2537
Country : US
Telephone Number : 209-559-8999
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/01/2022
Last Update Date : 02/01/2022

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Directions to “ COURTNEY LEE DERICHSWEILER ” Practice Location

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